The out-of-pocket cost for an average Medicare recipient is $3,024 a year, according to the study. That doesn’t include monthly premiums. And Medicare recipients pay on average $1,300 every time they’re hospitalized.

The report out Friday shows that although the program for those over 65 or disabled has a basic set of benefits, the real protection from medical bankruptcy comes with a pricey supplemental policy.

Their research found two-fifths of people with Medicare earn below $24,000 but spend 20 percent or more of their income on premiums with medical care. That includes costs covered by some insurance plans. Recipients’ payments don’t usually go far either, as Medicare excludes dental, vision and hearing coverage.

“Those that can are spending a lot on premiums for their insurance and are still at risk for out of pocket costs, particularly if they have middle or low incomes — meaning incomes in the $20,000 range, $30,000 range or lower — and that’s the majority of Medicare beneficiaries,” said Cathy Schoen, study author and Senior Scholar in Residence at the New York Academy of Medicine.

There is no cap on how much people can spend — a protection people on the individual market gained through the Affordable Care Act. With no limit to what they must pay out-of-pocket, some recipients can’t afford the supplemental plans that offer benefits that basic Medicare does not. Of people living below the poverty limit, 74 percent had no dental insurance during the year and less than half had an eye exam.

The numbers are a reminder that funding even basic level Medicare is important, according to Schoen. That’s done through a tax on employee earnings. By 2024, one in four U.S. residents will be over the age of 65. But there won’t be enough young people in the workforce to pay for those people’s Medicare coverage. The federal pot of money that pays for Medicare is due to run out in 2028.

That year was even sooner when the Affordable Care Act passed. But the ACA — also known as Obamacare — put more money in the Medicare fund. One of those things was a 0.9 percent income tax on people earning more than $200,000 a year.

In the House GOP’s American Health Care Act, that tax would be repealed. The Senate is now working on its own repeal and replace legislation, and it’s unclear if that tax repeal will be in it.

Many Medicare recipients in Kentucky area are also in the Medicaid program because they earn less than 138 percent of the poverty limit. In addition to the lack of dental and vision benefits in Medicare, the program also does not pay for nursing homes and long-term care. Medicaid picks up that tab.

Schoen with the Commonwealth Fund said that’s also why an awareness of Medicare’s flaws is important. That shines a spotlight on the repeal and replace legislation, because GOP legislators might change the way Medicaid is paid for, limiting the amount of money a state would get.

“If the state has less federal money to support those services, it could mean either cutting back on the number of people who are eligible, paying providers less or cutting back on benefits,” Schoen said.